Evaluation of the dizzy patient in the managed care environment

Evaluation of the dizzy patient in the managed care environment

P28 Otolaryngology Head and Neck Surgery May 1995 InstructionCourses--Sunday construction for large tumors, such as supraglottic tumors extending t...

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Otolaryngology Head and Neck Surgery May 1995


construction for large tumors, such as supraglottic tumors extending to the true cords or transglottic tumors involving the subglottis, ventricle, and false cord, which previously would have required either a total laryngectomy or a partial laryngectomy with permanent tracheostomy. The role of supracricoid laryngectomy after recurrence following irradiation will be discussed.

COURSE 1516-2 Two-period course ($40)

Room NOCC-65 12:30-2:45

Modern Vestibular Assessment and Rehabilitation Therapy STEVEN A. TELIAN,MD, and NEILT. SHEPARD,PhD Ann Arbor, Mich.

Educational objectives: To understand the role o f ENG, posturography, and rotational chair testing in the evaluation of patients with dizziness and to understand the physiologic rationale for vestibular rehabilitation therapy and the criteria for patient selection.

The evaluation of dizziness and disorders of equilibrium has become increasingly sophisticated. The introduction of computerized technology for the recording and analysis of eye movements has enhanced the diagnostic utility of both conventional electronystagmography and rotational chair testing. Dynamic posturography provides functional information regarding equilibrium and the ability to utilize sensory input to maintain balance. This modality has been influential in the design and monitoring of effective, customized vestibular rehabilitation programs for patients with balance disorders. This course will review current methods of vestibular assessment, including clinical methods for determining the level of vestibular compensation and for distinguishing the patient with an uncompensated stable vestibular lesion from those with progressive or unstable labyrinthine function. The role of vestibular rehabilitation in the management of the dizzy patient will be presented and illustrated with representative case studies.

COURSE 1517-2 Two-period course ($40)

Room NOCC-66 12:30-2:45

Evaluation of the Dizzy Patient in the M a n a g e d Care Environment DENNIS I. BOJRAB,MD, and CHARLESSTOCKWELL,PhD Royal Oak and Southfield, Mich.

Educational objectives: To evaluate the dizzy patient by understanding pathophysiology and testing and necessary diagnostics in the managed care environment to make an accurate diagnosis.

This 2-hour course is the basis for the understanding of the "dizzy patient" within the constraints of managed care.

We will cover epidemiology, skills of obtaining the medical history (questionnaire provided), and in-office physical examination with the use of the thorough otoneurologic examination; relevant basic vestibular pathway and important equilibrium anatomic relationships are discussed from both an anatomic and physiologic standpoint. Basic and advanced vestibular testing modalities are described and include ENG (traditional and computerized), rotation chair testing, posturography, and head shake testing. Emphasis is placed on understanding "when" which tests are necessary and how they are interpreted. New cranial and intracranial scanning techniques will be demonstrated, and the places for high-resolution CT scanning, MRI, MR-angiography, and SPECT scanning will be discussed as they relate to pathologic conditions. Laboratory testing to include hormonal, biochemical, immunologic, and chemical imbalances is discussed as it relates to the patient with dizziness. Audiometric analysis with emphasis on electrocochleography techniques will be reviewed. This 2-hour course outlines the basis for understanding and diagnosing patients with dizziness. The time is divided into logical topics with handouts for the practicing physician. This course serves as the framework to the sequel 1hour course, "Treatment of the Dizzy Patient," in which the treatment is learned by case presentations.

COURSE 1518-2

Two-period course ($40)

Room NOCC-80 12:30-2:45

Evaluation of Management of Unilateral Vocal Fold Paralysis MAISIE L. SHINDO, MD, and PEAKWOO, MD Los Angeles, Calif., and Boston, Mass.

Educational objectives: To understand relevant neuroanatomy and neurophysiology and therefore better identify etiology and pathophysiology of vocal cord paralysis and to systemically and logically evaluate and select appropriate treatment for patients with vocal cord paresis.

Vocal cord paralysis may be a manifestation of several different disease entities. It is important to accurately identify the etiology and the residual pathophysiology, so that treatment can be planned more rationally. An understanding of neurolaryngology and a systematic, logical approach to evaluation and treatment of vocal fold paresis will improve treatment outcome. The purpose of this course is to provide a comprehensive review of: 1. The relevant neuroanatomy and neurophysiology of the larynx 2. The causes and pathophysiology of vocal cord paralysis, including trauma, neoplasms, and various neurologic disorders 3. A variety of state-of-the-art diagnostic modalities that are currently used to aid in diagnosis and treatment planning, including videostroboscopy, electromyography, phonatory airflow studies, and glottography